Imaging of Bowel Ischemia: An Update, From the AJR Special Series on Emergency Radiology
Abstract
Acute mesenteric ischemia is a life-threatening condition that results from abrupt reduction in or cessation of blood flow to the bowel. Characterized by nonspecific abdominal symptoms, mesenteric ischemia is infrequently encountered and commonly misdiagnosed, with potentially catastrophic consequences. Prompt clinical diagnosis and early implementation of therapeutic interventions are critical to improving patient outcomes. Because cross-sectional imaging plays a key role in the diagnosis of mesenteric ischemia, radiologists must be familiar with the varied imaging manifestations of intestinal ischemia. Thus, the objectives of this article are to review the various types and common causes of mesenteric ischemia and to describe its spectrum of multimodality imaging findings, with special attention to novel imaging techniques and emerging diagnoses.
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Dual energy CT could potentially improve visualisation of the vessels and bowel wall and assist in the detection of subtle bowel wall hypo-enhancement in both occlusive and non-occlusive mesenteric ischaemia.
“Dual energy CT could potentially improve visualisation of the vessels and bowel wall and assist in the detection of subtle bowel wall hypo-enhancement in both occlusive and non-occlusive mesenteric ischaemia.”
Omitting the non-contrast CT is unlikely to result in a missed AMI diagnosis.
“Omitting the non-contrast CT is unlikely to result in a missed AMI diagnoses.”
In early AMI, early signs of intestinal injury are often present and can be subtle, such as bowel wall thickening, mild luminal dilatation, mesenteric oedema, and small amounts of peritoneal fluid.
“In early AMI, early signs of intestinal injury are often present. These can be very subtle and difficult to detect, such as bowel wall thickening, mild luminal dilatation (as a sign of bowel paralysis), mesenteric oedema (fat stranding), and small amounts of peritoneal fluid (Table 6). 118,133”
Cites
Acute Mesenteric Ischemia: A Clinical Review
Oldenburg, W. A., Lau, L. L., Rodenberg, T. J., Edmonds, H. J., & Burger, C. D. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.10.1054 · Cited by 714 · see citing works
Clair, D. G., & Beach, J. M. (2016) · New England Journal of Medicine · doi:10.1056/nejmra1503884 · Cited by 589 · see citing works
Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery
Bala, M., Kashuk, J., Moore, E. E., Kluger, Y., Biffl, W., Gomes, C. A., Ben-Ishay, O., Rubinstein, C., Balogh, Z. J., Civil, I., et al. (2017) · World Journal of Emergency Surgery · doi:10.1186/s13017-017-0150-5 · Cited by 574 · see citing works
Hagspiel, K. D., Flors, L., Hanley, M., & Norton, P. T. (2015) · Techniques in Vascular and Interventional Radiology · doi:10.1053/j.tvir.2014.12.002 · Cited by 88 · see citing works
Mesenteric ischemia: What the radiologist needs to know
Olson, M. C., Fletcher, J. G., Nagpal, P., Froemming, A. T., & Khandelwal, A. (2019) · Cardiovascular Diagnosis and Therapy · doi:10.21037/cdt.2018.09.06 · Cited by 83 · see citing works
Self-citationDual-energy CT of acute bowel ischemia
Obmann, M. M., Punjabi, G., Obmann, V. C., Boll, D. T., Heye, T., Benz, M. R., & Yeh, B. M. (2022) · Abdominal Radiology · doi:10.1007/s00261-021-03188-4 · Cited by 50 · see citing works
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Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
- Authors
- Olson, M. C., Bach, C. R., Wells, M. L., Andrews, J. C., Khandelwal, A., Welle, C. L., & Fidler, J. L.
- Affiliations
- Mayo Clinic (US)
- ORCID
- Venue
- American Journal of Roentgenology
- Publisher
- American Roentgen Ray Society
- Published
- 2023-02
- Volume
- 220
- Issue
- 2
- Pages
- 173-185
- ISSN
- 0002-9580 (ISSN-L)
- 0361-803X
- 1546-3141
- OpenAlex
- W4297830952
- Cited by
- 34
- References
- 6
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 6 · 2023: 6
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Roentgenology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, intestinal ischemia, multimodal imaging, emergency radiology
- MeSH terms
- Humans, Intestines, Ischemia, Radiology, Tomography, X-Ray Computed, Mesenteric Ischemia
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